Life Sciences & Health Care 03.04.2026

8 Min. Lesezeit

5-minute read

75 million electronic patient records (ePAs) have been created. Fewer than four percent of insured individuals actively use them. Just one in four hospitals has launched pilot operations. Meanwhile, digitalization penalties of up to two percent per billing case threaten from 2026 onward. The ePA is Germany’s largest healthcare digitalization initiative – and it’s stalled.

75 Million Records, 4% Users: ePA by the Numbers

Since its nationwide rollout in April 2025, every statutory health insurance member in Germany automatically receives an electronic patient record – unless they explicitly object. The opt-out model works: Only about 5% of insured individuals have filed objections – 4.3% at AOK, 7% at Techniker Krankenkasse, and even 10% at KKH.

The problem isn’t record creation – it’s usage. According to recent surveys, only around 4.2 to 4.6 million insured individuals have registered for a health ID – roughly 6% of GKV members. Actual active usage is even lower: An estimated 3.6% open their ePA regularly.

For hospitals and outpatient physicians, this means: The infrastructure exists on paper – but rarely enters daily care. Today, most patients undergoing hospital admission still encounter the familiar mix of paper forms, faxed reports, and phone follow-ups.

The federal government allocated €4.3 billion via the Hospital Future Act (KHZG) to change precisely that. McKinsey estimates the ePA’s annual savings potential at €7 billion – fewer duplicate exams, faster data exchange, and more efficient communication among general practitioners, hospitals, and specialists. Of the total healthcare digitalization potential – €42 billion per year – only a fraction has been realized so far: €1.4 billion (McKinsey eHealth Monitor, 2025).

Why Hospitals Are Stuck: KIS Updates, Staffing, and Processes

The DKI rapid survey from March 2026 – completed by 489 hospitals – paints a nuanced picture. Ninety percent of respondents have begun technical implementation. Forty percent are already piloting ePA integration within clinical workflows – a sharp rise from just 7% in September 2025.

But: 18% of hospitals are still waiting over five months past the mandatory deadline for their hospital information system (KIS) update. And 43% anticipate full hospital-wide ePA deployment only from Q3 2026. The bottleneck isn’t technology alone – it’s the underlying processes.

„Introducing the ePA in hospitals is a genuine transformation project requiring extensive procedural and organizational adjustments. Hospitals can’t simply flip a switch and make it work.“
– Prof. Dr. Henriette Neumeyer, Deputy Chair of the Board, German Hospital Association (DKG) (DKG press release, March 2026)

Organizational hurdles weigh heavier than technical ones. The ePA must integrate into existing admission workflows, access rights must be defined, data protection concepts updated, and medical staff trained. That consumes time and personnel capacity – both scarce resources in German hospitals.

Technical setbacks further erode trust. In February 2026, a smoke detector alarm at a Frankfurt data center disabled the entire Telematics Infrastructure for eight hours – rendering ePA, e-prescriptions, secure email (KIM), and electronic medication plans (VSDM) inaccessible. Also in February, a software error at AOK Bavaria erroneously locked and emptied 6,400 ePAs. In both cases, no data was lost – but the incidents confirmed skeptics’ concerns.

An underestimated challenge remains the TI connector replacement: Around 7,900 outdated TI connectors using obsolete RSA encryption must be replaced by end-2026, as certificate renewal is technically impossible. The eHBA smart card replacement runs in parallel until 30 June 2026. For hospitals still awaiting their KIS update, these challenges pile up.

Digitalization Penalty: What It Costs Hospitals Starting in 2026

Since 1 January 2026, penalties apply to five mandatory digital services. Any hospital unable to prove commissioning by 31 December 2025 incurs a surcharge on every billing case:

For a medium-sized hospital with 15,000 inpatient cases annually and an average revenue of €5,000 per case, the maximum 2% penalty translates to an annual loss of €1.5 million. These aren’t theoretical figures – they represent real losses for hospitals failing to commission all five mandatory services on time.

The escalation continues: By end-2027, at least 60% of inpatient cases must be digitally documented; by end-2028, that rises to 70%. Hospitals that meet the commissioning requirement but miss usage targets face renewed sanctions.

Estonia, Denmark, Germany: A Sobering Comparison

In the Bertelsmann Foundation’s Digital Health Index – which compares 17 OECD countries – Germany ranks 16th. Only Poland scores lower. Estonia and Denmark lead the field, having demonstrated functional digital healthcare for over a decade.

In Estonia, 99% of the population holds a digital patient record; 100% of physicians, hospitals, and pharmacies connect to the national ENHIS system. Its foundation is the X-Road infrastructure, which since 2002 has interoperably linked all public and private IT systems nationwide.

Denmark achieves near-100% e-prescription adoption and sees over one-third of its population use the national health portal sundhed.dk – generating 1.7 million monthly visits. General practitioners and pharmacies operate at 100% connectivity; specialists at 98%.

What unites both nations: centralized political leadership with binding targets, clear interoperability standards from day one, and tangible citizen benefits. The Bertelsmann Foundation identifies five success factors: strong governance, centralized steering instead of fragmented federalism, unambiguous interoperability standards, a constructive culture around errors, and visible added value for citizens.

Germany, by contrast, hosts 130 statutory health insurers – each with different apps – a Gematik caught between ministerial oversight and industry coordination, and 16 federal states pursuing divergent digitalization strategies. The result: Even the ambitious KHZG funding program failed to overcome structural fragmentation. PwC estimates hospitals bear roughly 16% of digitalization costs themselves – and cover 50-100% of ongoing operational expenses (PwC, November 2023).

What IT Leaders Should Do Now

The situation is unsatisfactory – but not hopeless. Those who set the right priorities now can avoid penalties while laying foundations for genuine hospital digitalization.

1. Clarify and escalate KIS update status. Eighteen percent of hospitals still await their KIS update. If the KIS vendor fails to deliver, document this in writing – not only as evidence for payers, but to prove delays aren’t self-inflicted.

2. Define and launch a pilot ward. The jump from 7% to 40% pilot participation shows: Starting yields progress. One ward suffices initially. Crucially, it’s not enough for technology to function – the ePA must integrate into physicians’ and nurses’ daily workflows.

3. Secure proof of commissioning for all five mandatory services. Penalties trigger upon missing commissioning – not delayed implementation. A signed contract or project order can prevent penalties, even if implementation remains underway.

4. Launch a training program. The DKI survey makes it clear: The bottleneck lies not in technology, but in organization. Training for physicians, nursing staff, and administrative personnel must run in parallel with technical implementation – not afterward.

5. Look ahead. The ePA isn’t an isolated IT project. It’s the foundation for the European Health Data Space (EHDS), scheduled to enable cross-border patient data exchange from 2029 onward. Building that foundation today positions your hospital for the next stage of networking. Waiting means catching up later – under even greater time pressure.

Frequently Asked Questions

What is the ePA opt-out rate?

On average, around 5% of statutory health insurance members have opted out of the ePA. Rates vary by insurer: 4.3% at AOK, 7% at Techniker Krankenkasse, and 10% at KKH. Opt-out numbers have stagnated since the April 2025 rollout.

What happens if a hospital fails to avoid the digitalization penalty?

The penalty applies to every inpatient and partial-inpatient billing case and may reach up to 2% of the case revenue. For a hospital with 15,000 cases annually and an average revenue of €5,000 per case, that amounts to up to €1.5 million per year. From end-2027, minimum usage quotas of at least 60% will also be enforced.

How does Germany compare internationally on digital patient records?

In the Bertelsmann Foundation’s Digital Health Index, Germany ranks 16th out of 17 OECD countries surveyed. Estonia (ranked #1) boasts 99% coverage and 100% physician connectivity – maintained for over a decade. Denmark achieves near-100% e-prescription adoption and draws 1.7 million monthly users to its national health portal.

What is the ePA’s savings potential?

According to the McKinsey eHealth Monitor 2025, the ePA alone could save approximately €7 billion annually – by reducing duplicate examinations, improving communication among providers, and accelerating access to patient data. McKinsey estimates the total annual digitalization potential across German healthcare at €42 billion.

Is the ePA secure?

At the end of 2024, the Chaos Computer Club identified theoretical vulnerabilities allowing unauthorized access to others’ records; Gematik closed the gap before the nationwide rollout. In February 2026, two incidents occurred: an eight-hour TI outage caused by a data center fault, and a data incident at AOK Bavaria where 6,400 records were mistakenly locked. No data was lost in either case – but the events confirm the infrastructure is still maturing.

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